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Is Low-Grade Intraventricular Hemorrhage in Very Preterm Infants an Innocent Condition? Structural and Functional
M I Argyropoulou1, L G Astrakas2, V G Xydis3
1From the Departments of Radiology (M.I.A., V.G.X., V.M., I.G.) margyrop@uoi.gr.
Insights
Very preterm infants with mild intraventricular hemorrhage show reduced gray matter, impaired white matter integrity, and altered brain activity. These neurodevelopmental differences highlight potential long-term impacts on brain development.
Area of Science:
- Neuroimaging
- Developmental Neuroscience
- Pediatric Neurology
Background:
- Increasing evidence links low-grade intraventricular hemorrhage (IVH) in very preterm infants to abnormal neurodevelopmental outcomes.
- Grades I and II IVH are considered mild but may have significant long-term effects.
Purpose of the Study:
- To evaluate the impact of mild intraventricular hemorrhage (IVH) on gray matter (GM) and white matter (WM) integrity in very preterm infants.
- To identify specific neurodevelopmental abnormalities associated with low-grade IVH.
Main Methods:
- MRI at term-equivalent age in 16 very preterm infants with mild IVH and 13 controls.
- Structural MRI for cortical surface area, thickness, and volume; resting-state fMRI for functional connectivity.
- Diffusion tensor imaging (DTI) with Tract-Based Spatial Statistics (TBSS) for WM microstructural integrity.
Main Results:
- Infants with mild IVH showed reduced GM surface area and volume in specific cortical regions (Brodmann areas 9, 10, 19, 45).
- Decreased fractional anisotropy (FA) in major WM tracts was observed, indicating microstructural abnormalities.
- Reduced brain activity in somatosensory cortex regions was detected in infants with mild IVH.
Conclusions:
- Low-grade IVH in very preterm infants is associated with regional cortical underdevelopment.
- Mild IVH can lead to functional impairment and microstructural immaturity of major white matter tracts.
- These findings suggest potential neurodevelopmental challenges in infants with mild IVH.
Background And Purpose:
There is increasing evidence of abnormal neurodevelopmental outcomes in very preterm infants with low-grade intraventricular hemorrhage grades I and II. Our purpose was to evaluate the effects of low-grade intraventricular hemorrhage on gray and white matter integrity.
Materials And Methods:
MR imaging at around term-equivalent age was performed in 16 very preterm infants (mean gestational age, 28.8 ± 5.3 weeks) with mild intraventricular hemorrhage on brain sonography and 13 control subjects (mean gestational age, 29.6 ± 4.1 weeks) without intraventricular hemorrhage. Structural and functional evaluation of the cortex was performed using regional measurements of surface area, thickness and volume, and resting-state fMRI, respectively, and of WM microstructural integrity, applying Tract-Based Spatial Statistics to diffusion tensor imaging data.
Results:
Compared with the control infants, the infants with low-grade intraventricular hemorrhage had decreases in the following: 1) GM surface area in Brodmann areas 19 left and 9 and 45 right, and GM volume in Brodmann areas 9 and 10 right; 2) fractional anisotropy bilaterally in major WM tracts; and 3) brain activity in the left lower lateral and in the right higher medial somatosensory cortex.
Conclusions:
Very premature infants with low-grade intraventricular hemorrhage at around term-equivalent age may present with regional abnormalities, appearing on imaging studies as cortical underdevelopment, functional impairment, and microstructural immaturity of major WM tracts.
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